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At a rally in Ohio last week, Mitt Romney said, “Obama-care is really Exhibit No. 1 of the president’s political philosophy, and that is that government knows better than people how to run your lives.” The GOP nominee added, “I don’t believe in a bigger and bigger government. . . . I believe in free people pursuing their dreams. I believe in freedom.”

Jason Seiler

This is a welcome and winning pitch from Romney. It puts the focus on Obama’s centerpiece legislation, which he spearheaded and signed into law against the clear will of the American people. In so doing, it highlights Obama’s big-government liberalism. And it sets up the key contrasts in this race—decentralized decision-making versus centralized power, prosperity versus profligacy, liberty versus coercion.

James Madison argued in Federalist 51 that our Constitution provides a “double security” to “the rights of the people.” One half of that security is the separation of powers among the three branches of government. The other half is federalism, the separation of powers between the federal government and the states. Madison argued that both of these checks on the concentration of power were essential to securing our rights.

Obama-care lays waste to half of this “double security” by funneling almost unimaginable levels of power and money to Washington. What’s more, in its startling delegation of de facto lawmaking power to the secretary of Health and Human Services (HHS) and other unelected figures in the executive branch, it also severely undermines the separation of powers among the branches. For example, Obama-care is making it illegal for anyone in America (with the narrow exception of houses of worship) to freely sell or buy an insurance plan that fails to offer free birth control and sterilization. But this ban is nowhere to be found in the 2,700 pages of the law itself. Rather, it came as a decree from HHS Secretary Kathleen Sebelius, exercising her newfound power. If Obama-care isn’t repealed, examples of such rule by fiat will proliferate.

This brings us back to Romney, the only man who stands in the way of Obama-care’s taking root from coast to coast. Over the next five weeks, Romney would do well to repeat at every turn what he said in Ohio. He should seize this golden opportunity to paint for voters the picture of their future under Obama-care. Here are just a few of the lowlights (courtesy of the Congressional Budget Office and/or the Medicare chief actuary) for voters to look forward to if Obama-care isn’t repealed:

At a time when the country is more than $16 trillion in debt, Obama-care will increase federal spending by about $2 trillion over the next decade. To partly cover this spending binge, it will impose 20 new or higher taxes, fees, or fines, totaling about $1 trillion. It will raise annual health care premiums by thousands of dollars per family for policies purchased on the open market. It will siphon $716 billion out of Medicare. And it will cut Medicare reimbursement rates to the point where Medicare providers are paid less than Medicaid providers by the end of this decade, jeopardizing seniors’ access to care.

It will establish the Independent Payment Advisory Board (IPAB), empowered to cut payments to Medicare providers even further. The decrees of this unelected and largely unaccountable board of 15 bureaucrats will not be reversible by a simple majority of the House and Senate—our Constitution’s vesting of the legislative power in Congress notwithstanding.

It will cause millions of Americans with employer-provided health insurance to lose their insurance. It will cause millions of seniors to lose their Medicare Advantage plans. It will dump more than a third of the newly insured into the already subpar Medicaid system at taxpayer expense. It will incentivize employers to dump their employees into Obama-care’s insurance “exchanges” at huge cost to taxpayers. It will force the young to help pay the health bills of those who are older and generally more affluent. It will force Americans of all ages to buy federally approved health insurance whether they want it or not.

Even beyond these requirements that the CBO and the Medicare chief actuary have highlighted, Obama-care will almost surely (depending on the decrees of the HHS secretary) make low-premium, high-deductible plans illegal. It will provide disincentives for businesses to hire additional workers. It will impose regulations so onerous that the IRS estimates it will take Americans 79 million man-hours a year to comply with them, with over half of that burden falling on small businesses. It will exacerbate a looming doctor shortage in several ways. It will load still more paperwork onto doctors, making the medical profession less attractive. It will add millions of people to the insurance rolls without adding doctors to see them, and put doctors under the yoke of the federal government. In its zeal to command and forbid, it bans new physician-owned hospitals. It promotes cronyism, as the well-connected get waivers from its mandates, while everyone else is compelled to comply (HHS has granted at least 1,200 waivers to date). And it inflames an already contentious issue by providing taxpayer funding of abortions.

Fifteen minutes of the first presidential debate are slated for health care. This gives Mitt Romney his big chance to remind the American people what life will be like under the president’s signature law as its various provisions take effect. Obama will doubtless attempt to turn that 15 minutes into a discussion of Romney’s proposals for Medicare, and moderator Jim Lehrer may try to oblige him. But Romney shouldn’t take the bait. His first and essential task in that quarter-hour is to drive home what health care in this country will be like under reforms that are already the law of the land. For the most important question Americans face in this, the most crucial election in decades, is: Do we want to keep Obama-care—or repeal it?